Establishing an EU-wide front-of-pack nutrition label: Review of options and model-based evaluation

This paper reviews the effectiveness of four types of front-of-pack nutrition labels (FoPLs) in influencing calorie purchases. The four FoPL types are poised for unified implementation across European countries. Further, this study extends its analysis to evaluate the impacts of the voluntary adoption of these FoPLs within 27 EU nations. Nutri-Score displays higher potential for yielding positive health and economic outcomes, compared with other FoPLs. Across EU countries, Nutri-Score is projected to avert nearly two million cases of non-communicable diseases, in total, between 2023 and 2050. Keyhole demonstrates effects of a similar magnitude but with no statistical significance. Nutri-Repere shows smaller impacts, while Nutri-Couleurs has non-significant effects. Nutri-Score is projected to significantly lower annual healthcare spending by 0.05%, whereas the other labels have negligible impacts. By reducing cases of disease, FoPLs have the potential to improve employment and work productivity. Nutri-Score surpasses the other labels with an estimated annual gain of 10.6 full-time equivalent workers per 100,000 individuals of working age across EU countries. In all, mandatory implementation of any of the four labels would lead to greater effects than those obtained with a voluntary implementation, providing evidence to inform legislation proposal for an EU-wide nutrition labelling system.

Tackling the cancer burden: the economic impact of primary prevention policies

Cancer is a noncommunicable disease (NCD) with increasing incidence and therefore constitutes a major public health issue. To reduce the health and economic burden of cancer, policy‐makers across the world have implemented a range of preventative interventions targeting risk factors with a known link to the disease. In this article, we examine the impact of six primary prevention interventions – related to physical inactivity, unhealthy diet or harmful alcohol use – on cancer‐related health outcomes and healthcare expenditure. Here, we used the OECD Strategic Public Health Planning for NCDs (SPHeP‐NCDs) model to quantify outcomes and costs for each intervention for years 2020–2050 across 37 countries. Results from the model indicate that all interventions could lead to a reduction in the number of new cancer cases, in particular those targeting harmful alcohol consumption. Introducing an alcohol tax, for instance, is estimated to reduce related cancer cases by 5619 a year or 174 193 by 2050. A breakdown of results by type of cancer revealed interventions had the largest impact on colorectal cancer with, on average, 41 140 cases avoided per intervention by 2050. In proportional terms, interventions had the greatest impact on new oesophageal and liver cancers. Findings from this article are designed to assist decision‐makers efficiently allocate limited resources to meet public health objectives.

Promoting sport and physical activity in Italy: a cost-effectiveness analysis of seven innovative public health policies

BACKGROUND

Inactive lifestyles are a key risk factor underpinning the development of many chronic diseases, yet more than half of the Italian population does not meet WHO thresholds for at least moderate physical activity. This study aims to make the economic case to upscale investments in policy actions to promote exercise and physical activity.

STUDY DESIGN

Modelling-based cost-effectiveness analysis in Italy.

METHODS

The study assesses the impact on health and healthcare expenditure of seven public health policies to promote exercise and physical activity against a business as usual scenario. Assessed policies include: promotion of active transport, workplace sedentarily interventions, investments in sports and recreation, mass media campaigns, prescription of physical activity in primary care, school-based interventions and mobile apps.

RESULTS

Public policies to promote exercise have the potential to improve population health and produce savings in healthcare expenditure. Assessed policies can avoid hundreds of cases of cardiovascular diseases and diabetes per year and tens of cases of cancer resulting in gains in DALYs in the order of thousands per year. In the medium-term, the vast majority of policies show excellent cost-effectiveness ratio, below internationally recognized thresholds.

CONCLUSIONS

Investing in policies to promote active lifestyles is a good investment for Italy.

Assessing the potential outcomes of achieving the World Health Organization global non-communicable diseases targets for risk factors by 2025: is there also an economic dividend?

OBJECTIVES

This study assesses the change in premature mortality and in morbidity under the scenario of meeting the World Health Organization (WHO) global targets for non-communicable disease (NCD) risk factors (RFs) by 2025 in France. It also estimates medical expenditure savings because of the reduction of NCD burden.

STUDY DESIGN

A microsimulation model is used to predict the future health and economic outcomes in France.

METHODS

A 'RF targets' scenario, assuming the achievement of the six targets on RFs by 2025, is compared to a counterfactual scenario with respect to disability-adjusted life years and healthcare costs differences.

RESULTS

The achievement of the RFs targets by 2025 would save about 25,300 (and 75,500) life years in good health in the population aged 25-64 (respectively 65+) years on average every year and would help to reduce healthcare costs by about €660 million on average per year, which represents 0.35% of the current annual healthcare spending in France. Such a reduction in RFs (net of the natural decreasing trend in mortality) would contribute to achieving about half of the 2030 NCD premature mortality target in France.

CONCLUSIONS

The achievement of the RF targets would lead France to save life years and life years in good health in both working-age and retired people and would modestly reduce healthcare expenditures. To achieve RFs targets and to curb the growing burden of NCDs, France has to strengthen existing and implement new policy interventions.

The short-term effect of BMI, alcohol use, and related chronic conditions on labour market outcomes: A time-lag panel analysis utilizing European SHARE dataset

INTRODUCTION

Non-communicable diseases (NCDs) like cancer, cardiovascular disease, and diabetes have spread at a remarkable pace in European countries over the past decades. Overweight/obesity and alcohol use are two leading risk factors contributing to both economic and epidemiological burden associated with NCDs. In OECD countries, the impact of indirect costs of obesity varies between 0.20% and 1.21% of GDP. Indirect costs of alcohol use range from 0.19% (Portugal) to 1.6% (Estonia) of GDP.

AIM

To assess the longitudinal impact of alcohol use and high body-mass index (BMI) on labour market outcomes in the European region by modeling the direct effect of high BMI and alcohol use, and the effect via associated diseases.

METHODS

The impact of BMI, alcohol use, and associated diseases on employment likelihood, intent to retire early, days of absenteeism, and hours of work per week, were modelled via lagged Poisson and Zero-inflated Poisson regressions, adjusting for missingness via inverse probability weighting, as appropriate, using European SHARE data.

RESULTS

Controlling for other chronic conditions, being overweight increases employment likelihood among men, but not among women. Obesity decreased female, but not male, employment chances. All chronic conditions linked with high BMI negatively affected employment likelihood, and increased the intention to retire early significantly. Alcohol use positively affects employment likelihood in women at all drinking levels relative to lifetime abstainers, but only in moderate (not heavy) male drinkers. There is super-additionality of impact of NCDs on absenteeism and hours worked, presenting a key economic argument to tackle NCD prevention and compression of morbidity.

IMPLICATIONS

NCD prevention is not just important for employment and hours worked, but also for employee morale, especially given increasing retirement age in Europe and globally.

Sentiment Analysis of Health Care Tweets: Review of the Methods Used

Background

Twitter is a microblogging service where users can send and read short 140-character messages called “tweets.” There are several unstructured, free-text tweets relating to health care being shared on Twitter, which is becoming a popular area for health care research. Sentiment is a metric commonly used to investigate the positive or negative opinion within these messages. Exploring the methods used for sentiment analysis in Twitter health care research may allow us to better understand the options available for future research in this growing field.

Objective

The first objective of this study was to understand which tools would be available for sentiment analysis of Twitter health care research, by reviewing existing studies in this area and the methods they used. The second objective was to determine which method would work best in the health care settings, by analyzing how the methods were used to answer specific health care questions, their production, and how their accuracy was analyzed.

Methods

A review of the literature was conducted pertaining to Twitter and health care research, which used a quantitative method of sentiment analysis for the free-text messages (tweets). The study compared the types of tools used in each case and examined methods for tool production, tool training, and analysis of accuracy.

Results

A total of 12 papers studying the quantitative measurement of sentiment in the health care setting were found. More than half of these studies produced tools specifically for their research, 4 used open source tools available freely, and 2 used commercially available software. Moreover, 4 out of the 12 tools were trained using a smaller sample of the study’s final data. The sentiment method was trained against, on an average, 0.45% (2816/627,024) of the total sample data. One of the 12 papers commented on the analysis of accuracy of the tool used.

Conclusions

Multiple methods are used for sentiment analysis of tweets in the health care setting. These range from self-produced basic categorizations to more complex and expensive commercial software. The open source and commercial methods are developed on product reviews and generic social media messages. None of these methods have been extensively tested against a corpus of health care messages to check their accuracy. This study suggests that there is a need for an accurate and tested tool for sentiment analysis of tweets trained using a health care setting–specific corpus of manually annotated tweets first.

A patient-centric approach to improving experience in urological cancer care

Rationale:

Patient experience data are often reported at the provider level rather than the patient level, meaning that providers receive an aggregate score of all patient experience scores across their service. This inflates positivity and makes it difficult for providers to use patient experience scores to tailor improvements for patients within specific sites, wards or pathways. Patients have different priorities for their urological cancer care experience, and improvement programmes should take these differences into account. A more granular understanding of different patterns of patient experience will allow health care providers to focus their improvement strategies differently based on the needs of the patient groups that utilise their services.

Objective:

This study examines what groups exist within the urological cancer patient population, and what are their respective priorities for patient experience improvement.

Methods:

Using urological cancers as a case study, this paper uses data from the UK National Cancer Patient Experience Survey to segment the patient population based on their scores for 14 domains of experience. TwoStep cluster analyses were carried out on two groups of survey respondents: those who had an operation and those who did not. These analyses identified previously unknown clusters within the two populations. Profiles were created for each cluster based on a series of demographic variables, and a regression analysis was conducted to assess the significance of each demographic variable in determining cluster membership.

Results:

The TwoStep analysis yielded three clusters for both the operations and non-operations groups based on how patients experienced care: Positive, Middling and Negative. Gender, age, cancer type and income significantly influenced cluster membership: women, younger and more deprived patients were more prevalent in the Negative experience cluster.

Conclusion:

This more nuanced understanding of the patient population and the variation in their priorities for patient experience improvement is the first step to more patient-centric improvement. It will allow services to make more meaningful and individualised changes based on the voices of patients. This is a proof of concept that can be applied broadly in health care to more effectively deliver on the patient-centred agenda.

Meta-analysis of population-based studies comparing risk of cerebrovascular accident associated with first- and second-generation antipsychotic prescribing in dementia

BACKGROUND

Second-generation antipsychotics (SGAs) are often prescribed in the treatment of Behavioral and Psychological Symptoms of Dementia (BPSD), however, their use has been discouraged in light of clinical trials suggesting that they cause an increased risk of cerebrovascular accidents (CVAs).

OBJECTIVE

Aim of the study was to assess relative risk of CVA in dementia patients prescribed SGA rather than first-generation antipsychotics (FGAs), through meta-analysis of population-based studies.

METHODS

A literature search was conducted using several relevant databases. Five studies were included in the review and data were pooled to conduct meta-analysis using the inverse variance method.

RESULTS

A total of 79,910 patients were treated with SGAs and 1287 cases of CVA were reported. Of 48,135 patients treated with FGAs, a total of 511 cases of CVA were reported. The relative risk of CVA was 1.02 (95% CI 0.56-1.84) for the SGA group. There was no significant difference in the risk of stroke (p = 0.96) between groups, but significant heterogeneity was found among the results of included studies (p < 0.001).

CONCLUSION

Meta-analysis of population-based data suggested that the use of SGAs as opposed to FGAs to control BPSD is not associated with significantly increased risk of CVA. Copyright © 2016 John Wiley & Sons, Ltd.